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Investigation of Potential HIV Transmission to the Patients of an HIV-Infected Surgeon
Audrey Smith Rogers, PhD, MPH;
John W. Froggatt III, MD;
Timothy Townsend, MD;
Toby Gordon, ScD;
Andrew J. Leigh Brown, PhD;
Edward C. Holmes, PhD;
Lin Qi Zhang, PhD, MSc;
Hamilton Moses III, MD
JAMA. 1993;269(14):1795-1801.
Abstract
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Objective.
—To ascertain if a surgeon infected with the human immunodeficiency virus (HIV) transmitted HIV to patients during invasive surgical procedures.
Design.
—Survey of patients and acquired immunodeficiency syndrome (AIDS) case registries, and laboratory analysis of nucleotide sequence data.
Setting.
—One surgeon's private and institutional practices within one academic referral hospital.
Patients.
—A total of 1131 persons identified in hospital databases who underwent invasive surgical procedures from 1984 through 1990 and for whom the surgeon was listed as the admitting or operating surgeon.
Measurement.
—Patients presumed to be living were surveyed by mailed questionnaire. The AIDS case registries were reviewed for all patients having undergone invasive procedures and death certificates were obtained. Person-hours of surgery during which exposure might have occurred were calculated for surgical procedures.
Results.
—Of 1131 patients, 101 were dead, 119 had no address, 413 had test results known, and 498 did not respond to the questionnaire. No study patient name was found in reported AIDS case registries. One newly detected, HIV-seropositive patient was determined (through nucleotide sequencing) to have been most probably infected in 1985 during a transfusion. There was no HIV transmission in 369 person-hours of surgical exposure, indicating that HIV transmission to patients is unlikely to occur more frequently than once per 1000 person-hours of surgical exposure.
Conclusions.
—If study validity and resources permit, investigation of publicly disclosed, HIV-infected health care workers whose practices involve invasive procedures should be pursued. The risk of HIV transmission during surgery may be so small that it will be quantified only by pooling data from multiple, methodologically similar investigations.
(JAMA. 1993;269:1795-1801)
Author Affiliations
From the AIDS Administration, Maryland State Department of Health and Mental Hygiene, Baltimore, Md (Dr Rogers); The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Froggatt, Townsend, and Gordon); the Division of Biological Sciences, University of Edinburgh (Scotland) (Drs Leigh-Brown, Holmes, and Zhang); and The Johns Hopkins Hospital, Baltimore, Md (Dr Moses). This study was conducted at the AIDS Administration, Maryland State Department of Health and Mental Hygiene, Baltimore.
Footnotes
The views in this article are those of the authors and do not necessarily represent the views of the agencies with which the authors are affiliated.
Reprint requests to the Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bldg 6100, Room 4B 11, 6100 Executive Blvd, Rockville, MD 20892 (Dr Rogers).
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